Transcript Slide 1
Reforming Health Care Law and Policy: Achieving Universal Health Care in 2008
Congressman John Conyers
Chairman, Committee on the Judiciary U.S. House of Representatives
Presented by: Northwestern University School of Law , Feinberg School of Medicine, American Constitution Society and the American Medical Student Association
Achieving Universal Health Care in 2008
Options for and Implications of Reform
Nicholas Skala Senior Research Associate Physicians for A National Health Program [email protected]
United States
:
47 Million Uninsured
Institute of Medicine: 18,000 Deaths Per Year
But simply helping them buy private insurance is not a solution.
Meet Thomas Wilkes
Born in 2003 with Severe Hemophilia A.
Dad: Senior Engineer at a high tech computer firm with good benefits.
2004: Develops an inhibitor to his hemophilia treatment.
$750,000 annual claims.
Private Insurance for Thomas
Company faces 40% to 55% increase in premiums.
Only insurer that will cover them requires $10,000 out-of-pocket and a $1 million cap.
Thomas is projected to reach the $1 million benefit cap in summer 2008.
Options for Thomas’ Family
1.
Thomas’ father can quit the job he loves and go to work for a mega-firm that will take longer to be affected by high claims.
2.
Thomas’ mother can stop raising the children and go to work for a mega-firm.
3.
Thomas’ father can divorce his mother to leave her and Thomas legally destitute and eligible for public programs.
America’s Underinsured Proportion of Americans Going Without Care due to Costs, 2005 (skipping doctor visit, specialist appointment, treatment or prescription when needed)
Insured Insured, Gap in Coverage Uninsured 70 60 50 40 28 30 20 10 0
Source: Commonwealth Fund Biennial Health Insurance Survey, 2005
60 59
Medical Bankruptcy
Illness and Medical Bills Contributed to 1,000,000 Personal Bankruptcies in 2004. (Half of All Bankruptcies) Insurance Status at Onset of Illness 24.3% Uninsured Had Insurance 75.7%
Source: Himmelstein, Health Affairs 2005 (state estimates provided by author)
Rising Costs = Less Benefits = Under/Uninsurance
Proportion of Americans Covered by Employer Insurance
70.0% 68.0% 66.0% 64.0% 62.0% 60.0% 1999 2000 2001 2002 2003 2004 2005
Source: US Census
Expansion of Public Programs: An SCHIP Math Problem!
8 Million Uninsured Kids (1995) 5 Million get coverage through SCHIP 5 Million more become uninsured
+ -
Expansion of Public Programs: A Zero Sum Game
Number of Uninsured Kids (0-18 yrs.) 1988 - 2005
12000 11000 10000 9000 8000 7000 6000 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05
Source: U.S. Census Bureau
Lesson #1: Simply Giving More People Existing Private Insurance Policies Is Not a Solution.
•Current Private Insurance Policies Offer Inadequate
Protection.
•Any Gains in Coverage Will Be Quickly Offset as
Costs Rise and Employers Shed Benefits.
Lesson #2: Any Real Solution to the Health Crisis Must Do Two Things: 1) Offer Coverage More Comprehensive than that Currently Available on the Private Market.
2) Control Costs so that Benefits are Sustainable.
77.8
Life Expectancy, 2005
(Data in Years)
80.3
80.2
80.4
80.6
79 79 U.S.
U.K.
Germany France Canada Italy Sweden
6.8
Infant Mortality, 2005
(Deaths in first year of life per 10,000 live births)
5.3
5 4.7
3.9
3.6
2.4
U.S.
Canada Australia Italy Germany France Sweden
International Health Spending, 2005
U.S. Public Spending is Greater than Other Nations’ Public/Private Spending Combined
$6,000 $4,000 $2,000 $0 Ja p an It
Source: OECD 2007; Japan data are from 2004
al y U .K
.
S w ed en G er m an y C an ad a F ra nc e U .S
.
60 Percent of health Care Costs 50 40 30 20 10 0
If you were in an insurance CEO, who would you want to insure?
80
73%
70
0% 0% 0% 1% 1% 2% 4% 6% 13%
10% 10% 10% 10% 10% 10% 10% 10% 10% 10% Source:Agency for Healthcare Research and Quality MEPS
The Health and Profitable to the “Market,” the Sick and Poor to the Taxpayer 80
73%
70
Government Programs
60 Percent of health Care Costs 50 40 30
Private Insurers
20
13%
10
0% 0% 0% 1% 1% 2% 4% 6%
0 10% 10% 10% 10% 10% 10% 10% 10% 10% 10% Source:Agency for Healthcare Research and Quality MEPS
Growth of Physicians and Administrators
1970-2005
3000% 2500% 2000% 1500% 1000% 500% 0% 1970 1975 1980 1985 1990 1995 Physicians Administrators
Source: Bureau of Labor Statistics and NCHS
2000
One-Third of Health Spending is Consumed by Administration
31% Administration All Other
Potential Savings: $350 billion per year Enough to Provide Comprehensive Coverage to Everyone Source: Woolhandler, et al, New England Journal of Medicine, August 2003 & Int. Jrnl. Of Hlth. Services, 2004
Financing Single-Payer
Medicare Medicaid Payroll Tax Income Tax
Single-Payer Health Care Fund $$$
Bonus: Negotiated formulary with physicians, global budget for hospitals, increased primary and preventive care, reduction in unnecessary high-tech interventions, bulk purchasing of drugs and medical supplies = long term cost control.
Single-Payer Benefits
Comprehensive Coverage for all medically necessary services (doctor, hospital, long-term care, mental health, vision, dental, drug, etc.) in a single-tier system .
Free Choice of doctor and hospital.
Health Workers Unleashed from corporate dictates over patient care.
Hospitals guaranteed a secure, regular budget.
Only
Two Paths to Reform
1.
Preserve Private Insurance Companies and their Waste 2.
Create a National Health Insurance System
The Republicans
“Consumer-Directed Health Care”
Health Savings Accounts
A bank account in which a limited amount of money may be deposited tax-free for expenditures on health services.
Must be paired with a “high-deductible” health plan. (e.g., $5,000).
First few thousand dollars are paid from the HSA, at some point, “catastrophic” coverage kicks in.
Theory : Patients now using “their own money” = better consumers = lower costs.
High-Deductibles = No Savings
80 70 60 Percent of health Care Costs 50 40 30 20 10 0
0% 0% 0% 1% 1% 2% 4% 6% 13% 73%
10% 10% 10% 10% 10% 10% 10% 10% 10% 10% Source:Agency for Healthcare Research and Quality MEPS
Health Savings Accounts
Won’t
•Provide Meaningful Choice for Patients •Reduce Administration •Produce Savings
Health Savings Accounts
Will
•Discourage Preventive and Primary Care •Create Huge New Administrative Waste •Produce Few Savings (a few sick people cost the most)
Market Medicine: A “Nearly Stupid” Idea?
I do not believe that making the individual patients more “cost-sensitive” has any rationale in science, ethics, or medicine. It will fail, and it will fail miserably.
It will result in a shifting of care away from the people who need it the most. If Xerox or GE can’t change health care using their purchasing power, then I absolutely promise you that Mrs. Jones can’t.
bucks out of pocket is, to me, nearly stupid
.
The idea that she will now be more sensitive because she pays an extra ten
- Dr. Donald Berwick Institute for Healthcare Improvement
“Individual Mandate”
“Let them buy insurance.”
Criminalizing the Uninsured: A Massachusetts Punitive Index
# The Crime
1 2 3 4 5 6 7 Violation of Child Labor Laws Illegal Sale of Firearms, First Offense Driving Under the Influence, First Offense Domestic Assault Cruelty to or Malicious Killing of Animals Communication of a Terrorist Threat Being Uninsured*
The Fine
$50 $500 max.
$500 min.
$1000 max.
$1000 max.
$1000 min.
$1500 min.
*Note: Original version of House Bill would have suspended individuals’ driving licenses for uninsurance as well.
Subsidy and Individual Mandate Schemes
Substandard Coverage
: forces the uninsured to buy defective insurance industry products that are already causing families to face bankruptcy and go without needed care.
Unaffordable
: Without the savings achievable with single-payer, taxes must raised or funds diverted from other needy programs.
Micro-coverage, Macro-costs
: Preserves wasteful private insurers and adds yet another layer of state administrative waste. Rather than provide care to the uninsured through a relatively efficient program like Medicare, the plan launders tax dollars through wasteful private insurers.
No Realistic Cost Control
: Any gains in public coverage will be unsustainable due to rising costs.
“Sounds Great, but it’s not politically feasible”
2/3rds of population want it
Most (59 percent) of physicians want it
Business community is now realizing the need for it.
Single-Payer:
Glen Barton Former CEO, Caterpillar Inc. (Fortune 100) Past Chairman, Health and Retirement Task Force Business Roundtable Represents 150 Largest Employers Total Assets: $4.0 Trillion
“The quickest and simplest solution… is to go to a single-payer system” - Written Testimony to AHCTF, Feb. 1 2006
“If done right, health care in America could be dramatically better with true single-payer coverage.” Ben Brewer, WSJ, April 18, 2006 “[single-payer] is an idea that's so easy to slam politically yet so sensible for business that only Republicans can sell it! …it may take a Republican President to bless the socialization of health spending we need.” -Matt Miller, Fortune, April 18, 2006
CNBC / MSN Money
“Think, as a small business, how you could benefit from a single-payer system: you wouldn’t lose potential employees to larger firms that offer more attractive health benefits; health insurance costs would cease to be a line item in your budget. A serious illness befalling you or an employee wouldn’t be a company wide financial crisis. You might even save money.” -Joseph Antony, CNBC / MSN Money, Winter 2003
Is “The Perfect the Enemy of the Good?” The Radical and the Republican
“Many of Lincoln’s admirers have painted him as a man who wanted exactly what the abolitionists did but cannily waited for a perfect moment to achieve it. [In fact], radicals like Douglass set an agenda Lincoln gradually adopted as his own. Without abolitionists, there would have been no Lincoln.”
- James Oakes, Historian, UC Berkeley
Single-Payer: “Politically Feasible?”
Other “Politically Infeasible” Movements
Abolition of Human Slavery
(1860s)
Women’s Suffrage Movement
(1840-1920)
Civil Rights Act
(1964)
Reforming Health Care Law and Policy: Achieving Universal Health Care in 2008
Congressman John Conyers
Chairman, Committee on the Judiciary U.S. House of Representatives
Presented by: Northwestern University School of Law , Feinberg School of Medicine, American Constitution Society and the American Medical Student Association